NCJ Number
189736
Date Published
April 2002
Length
239 pages
Annotation
This second of two volumes presents papers (summarized in volume 1) that document the health status of inmates about to be released from prison, as well as the cost effectiveness of treating several of these diseases while the inmates are in prison; policy recommendations are intended to improve disease prevention, screening, and treatment in prisons and jails.
Abstract
As of 1999, an estimated 2 million individuals were incarcerated in the Nation's jails and prisons. Approximately 11.5 million inmates were released into the community in 1998, most from city and county jails. Papers presented in this report indicate that tens of thousands of these inmates have communicable diseases, chronic diseases, and mental illness. Some of the communicable diseases are sexually transmitted diseases, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis B and C, and tuberculosis. In addition to the risk that these diseases may be transmitted to jail and prison staff and inmates, inmates released with these communicable diseases threaten public health. In 1995, the chronic disease of asthma among Federal, State, and local inmates was estimated to be between 8 and 9 percent; and the prevalence of diabetes, another chronic disease, was estimated to be about 5 percent. In this same year, 18 percent of inmates were estimated to have chronic hypertension. Mental illness was also prevalent among inmates, with relatively high percentages having major depression and some type of anxiety disorder. Studies indicate that few prisons and jails have adequate prevention, screening, and treatment programs for communicable and chronic diseases or mental illness. Further, the continuity of care for inmates released with these diseases is especially inadequate. Many prisons and jails fail to conform to nationally accepted clinical guidelines for inmate health care. Regarding the cost-effectiveness of instituting prevention, screening, and treatment of disease among prison and jail inmates, studies indicate that effective early intervention saves more money in averted medical costs than is needed to implement it. Effective screening followed by scientifically effective treatment for communicable diseases and chronic diseases particularly can avert the costly spread and long-term treatment of such diseases. Despite the compelling reasons for improving the prevention, screening, and treatment of disease among inmates, significant barriers can make it difficult for prisons and jails to improve these services. Impediments include lack of leadership, logistical barriers, limited resources, and existing correctional policies. Suggestions are offered for overcoming these barriers. The policy recommendations presented are based on a consensus among a number of the Nation's leading experts in correctional health care and public health. They propose interventions for which there is strong, and in many cases even overwhelming, scientific evidence of therapeutic effectiveness. The proposals also take into account what correctional systems can reasonably be expected to achieve in health care. Papers are accompanied by relevant figures and tables as well as notes. Appended list of project participants, biographies of contributors, and information about the National Commission on Correctional Health Care and its position statements